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At least 1,027 records · Page 57Linked to original sources
PubMed2006

Endoscope-assisted submandibular sialoadenectomy: a pilot study.

PURPOSE: To describe an endoscopic technique for submandibular sialoadenectomy in humans, as well as the equipment, instrumentation, and pertinent anatomy. MATERIALS AND METHODS: Six submandibular sialoadenectomies were carried out in 5 patients (3 women, 2 men; mean age, 26.6 years; range, 16 to 42 years) via a 15 to 20 mm neck incision for insertion of the endoscopic camera and surgical instruments. RESULTS: All operations were successful without conversion to an open surgery. Operative time was 20 to 120 minutes (mean, 65 minutes). All patients were discharged the day after surgery. There were no postoperative complications (hematoma, nerve injury, infection). All patients experienced a mild degree of edema, which had resolved totally at the 6-month follow-up visit. All patients were satisfied with the outcome and especially the cosmetic result. CONCLUSIONS: Absence of extensive scars, nontraumatic dissection, and magnification of anatomic structures are the most obvious advantages of this innovative technique.

Adenoma, Pleomorphic↗
PubMedDate not supplied

Advanced virtual endoscopic pituitary surgery.

Endoscopy has recently been introduced to endonasal transsphenoidal pituitary surgery as a minimally invasive procedure for the removal of various kinds of pituitary tumors. To reduce morbidity and mortality with this new technique, the surgeon must be well-trained and well-prepared. Virtual endoscopy can be beneficial as a tool for training, preoperative planning, and intraoperative support. This paper introduces STEPS, a virtual endoscopy system designed to aid surgeons in getting acquainted with the endoscopic view of the anatomy, the handling of instruments, the transsphenoidal approach, and challenges associated with the procedure. STEPS also assists experienced surgeons in planning a real endoscopic intervention by getting familiar with the individual patient anatomy, identifying landmarks, planning the approach, and deciding upon the ideal target position of the actual surgical activity. The application provides interactive visualization, navigation, and perception aids and the possibility of simulating the procedure, including haptic feedback and simulation of surgical instruments.

Algorithms↗
PubMedDate not supplied

Laparoscopic myomectomy for very large myomas using an isobaric (gasless) technique.

OBJECTIVES: Laparoscopic myomectomy using pneumoperitoneum for large myomas (> or = 8 cm) is hindered by several factors, such as the increased operative time, the risk of perioperative bleeding, and the risk of conversion to laparotomy. With the introduction of isobaric laparoscopy using abdominal wall lifting, this procedure can be performed using conventional surgical instruments introduced through small abdominal incisions. The aim of this study was to evaluate the feasibility, reproducibility, and safety of isobaric laparoscopic myomectomy for very large myomas > or = 10 cm using a subcutaneous abdominal wall-lifting device. METHODS: A series of 24 consecutive patients with at least 1 symptomatic myoma > or = 10 cm underwent a gasless laparoscopic myomectomy with the Laparotenser device. Conventional long laparotomy instruments were used. RESULTS: Gasless laparoscopic myomectomy was successful in all 24 consecutive patients. The size of the dominant myoma varied from 10 cm to 20 cm. The median operating time was 93 minutes. The median postoperative drop in hemoglobin was 2.8 g/dL. No surgical complications occurred. The median hospital stay was 2.8 days. CONCLUSION: Gasless laparoscopic myomectomy is feasible, reproducible, and safe for removing very large myomas. Therefore, it can represent an excellent option for the minimally invasive removal of very large myomas.

Adult↗
PubMed2000

Complications of hysteroscopy: a prospective, multicenter study.

OBJECTIVE: To estimate the incidence of complications of diagnostic and operative hysteroscopic procedures in the Netherlands and describe their nature. METHODS: Data on complications were recorded by 82 hospitals in 1997. Participating hospitals had a 100% response rate. Any unexpected events that required intraoperative or postoperative intervention were defined as complications in two groups: approach (entry-related) and technique-related (caused by surgical instruments). RESULTS: Thirty-eight complications occurred among 13,600 hysteroscopic procedures (rate 0.28%). Diagnostic hysteroscopic procedures had a significantly lower complication rate (0.13%) than operative procedures (rate 0.95%; P <.01). Fluid overloads of distention medium were recorded five times (rate 0.20%). The most frequent surgical complication was perforation of the uterine cavity (rate 0.76%). Approximately half the perforations (18 of 33) were entry-related. Bleeding caused by perforation was seen in 0.16% of cases. Incidences of complications were: intrauterine adhesiolysis 4.48%, endometrium resection 0.81%, myomectomy 0.75%, and removal of a polyp 0.38%. CONCLUSION: Diagnostic hysteroscopic procedures had very low complication rates, so are safe procedures with which to evaluate intrauterine pathology. Operative hysteroscopic procedures were more risky, but the removal of polyps had a very low complication rate (12 times lower than synechiolysis). Half the complications were entry-related, so attention has to be paid to the method of entry with the hysteroscope (ie, no unnecessary dilation of cervix and introduction of the scope under direct vision). The other half of complications were related to surgeons' experience and type of procedure.

Female↗
PubMed1998

Measurement of intraoperative brain surface deformation under a craniotomy.

OBJECTIVE: Several causes of spatial inaccuracies in image-guided surgery have been carefully studied and documented for several systems. These include error in identifying the external features used for registration, geometrical distortion in the preoperative images, and error in tracking the surgical instruments. Another potentially important source of error is brain deformation between the time of imaging and the time of surgery or during surgery. In this study, we measured the deformation of the dura and brain surfaces between the time of imaging and the start of surgical resection for 21 patients. METHODS: All patients underwent intraoperative functional mapping, allowing us to measure brain surface motion at two times that were separated by nearly an hour after opening the dura but before performing resection. The positions of the dura and brain surfaces were recorded and transformed to the coordinate space of a preoperative magnetic resonance image, using the Acustar surgical navigation system (manufactured by Johnson & Johnson Professional, Inc., Randolph, MA) (the Acustar trademark and associated intellectual property rights are now owned by Picker International, Highland Heights, OH). This system performs image registration with bone-implanted markers and tracks a surgical probe by optical triangulation. RESULTS: The mean displacements of the dura and the first and second brain surfaces were 1.2, 4.4, and 5.6 mm, respectively, with corresponding mean volume reductions under the craniotomy of 6, 22, and 29 cc. The maximum displacement was greater than 10 mm in approximately one-third of the patients for the first brain surface measurement and one-half of the patients for the second. In all cases, the direction of brain shift corresponded to a "sinking" of the brain intraoperatively, compared with its preoperative position. Analysis of the measurement error revealed that its magnitude was approximately 1 to 2 mm. We observed two different patterns of the brain surface deformation field, depending on the inclination of the craniotomy with respect to gravity. Separate measurements of brain deformation within the closed cranium caused by changes in patient head orientation with respect to gravity suggested that less than 1 mm of the brain shift recorded intraoperatively could have resulted from the change in patient orientation between the time of imaging and the time of surgery. CONCLUSION: These results suggest that intraoperative brain deformation is an important source of error that needs to be considered when using surgical navigation systems.

Adult↗
PubMed1996

Neurosurgery in a patient with Creutzfeldt-Jakob disease after pituitary derived growth hormone therapy in childhood.

The case of a young man who had previously received pituitary derived growth hormone for treatment of radiation induced growth hormone deficiency is reported. He underwent neurosurgery for presumed recurrence of a posterior fossa tumour but was subsequently shown to have Creutzfeldt-Jakob disease, confirmed on necropsy. The risk of transmission of Creutzfeldt-Jakob disease by neurosurgical instruments is discussed. Since the occurrence of this case the Department of Health have issued guidelines concerning neurosurgery and ophthalmic surgery in patients who have previously received treatment with pituitary derived growth hormone and may therefore be at risk of developing Creutzfeldt-Jakob disease. Surgical instruments used on such patients should under no circumstances be reused, and should be destroyed after use.

Astrocytoma↗
PubMed2001

[ND YAG laser in senile cataract microsurgery].

PURPOSE: To enlarge indications for Nd YAG laser anterior capsulotomy in extracapsular extraction of senile cataract and to improve the methods for its implementation. MATERIAL AND METHODS: Nd YAG laser anterior capsulotomy we accomplished in 618 eyes of patients with senile cataract. The eyes we divided in groups according to the matureness of the cataracta. The laser capsulotomy was implemented during the ECCE. We created the methods we used: "symmetric ascending on circumference", "horizontal linerar", "circular", "methods for expholiations". RESULTS AND DISCUSSION: In all 618 eyes we implemented successful Nd YAG laser anterior capsulotomy. It had smooth edges and was precise, sharply shared and executed with maximum saving of the adjacent tissue. The Nd YAG laser anterior capsulotomy as part of the ECCE helped to minimize duration of the surgery intervention and to increase the number of the operations, which can be implemented in the surgical time. We enlarged the indications for Nd YAG laser anterior capsulotomy in extracapsular extraction of senile cataract and opposing to other authors /7/ we agreed that as a method it is extremely appropriate in cases like cataracta senilis, matura and hypermatura in which an instrumental surgical intervention is possible to lead to some complications concerning zonula Zinni damaging. CONCLUSION: The use of Nd YAG laser for capsulotomy during the ECCE gives the opportunity to anticipate the pathological response of the eye tissues and to retain clear cornea and normal IOP. The methods we offered--"symmetric ascending on circumference", "horizontal linerar", "circular" and "methods for expholiations"--support the implementation of precise, sharply shared anterior capsulotomy with maximum preserving of the adjacent tissue. The successful capsulotomy provides for optimum conditions for the next steps in the operation, minimization of the surgical time, tranquil postoperative period. The Nd YAG laser anterior capsulotomy has found its place as a part of the modern ophthalmosurgery.

Aged↗
PubMed2004

[Surgical treatment of colorectal liver metastasis in the year 2000].

There is significant recent progress in the surgical and oncological treatment of colorectal liver metastases. In our review we try to explain the variability and the multidisciplinarity approach we use to treat our patients more successful after the year of 2000. Beside the old rule: "Resect if possible"--thanks to the improvement of chemotherapy and new surgical instruments- there are new trends: "Make it resectable" or "resect it as many times as possible" thanks to the loco-regional and systemic neoadjuvant chemotherapy and/or the repeated interventions in metastasis surgery. The most important prognostic factors influencing the overall survival rate are free surgical margins, synchronous or metachronous metastasis and the need for repeated interventions. The view about extra hepatic metastases of CRC is changed in the last decade as the resection of these metastases is also suggested. After the year 2000 colorectal liver metastases should be treated "a-la-carte", based on multidisciplinary planning and treatment in specialised centres providing the long survival rates.

Chemotherapy, Adjuvant↗
PubMed1986

Myocardial depression during acute pancreatitis: fact or fiction?

Clinical and experimental evidence suggests that myocardial depression occurs during severe pancreatitis, but this evidence is derived from techniques that are not optimal for assessing myocardial contractility (e.g., rate of rise in ventricular pressure [dP/dt]). The slope of the left ventricular (LV) and systolic pressure dimension relationship (Ees), a better indicator of myocardial function, has not been measured in pancreatitis. Ten mongrel dogs underwent surgical instrumentation to monitor systemic arterial and LV pressure, cardiac output, LV dP/dt, and anterior LV wall thickness. End of systole was defined by the peak negative dP/dt. The end-systolic points used to calculate Ees were obtained by aortic and vena caval occlusion. After surgical recovery, pancreatitis was induced via cannulation of the pancreatic duct and injection of autologous bile (1 ml/kg) at 200 mm Hg perfusion pressure. All measurements were taken during a control period and daily after pancreatitis was induced. Pancreatitis was confirmed by a significant increase in serum amylase throughout the study and by autopsy finding of hemorrhagic necrosis. Ees was increased throughout the experimental protocol (1 to 7 days) (p less than 0.05). Myocardial performance as assessed by Ees was significantly increased and myocardial depression did not occur in untreated, conscious dogs with severe pancreatitis. Peak positive LV dP/dt was a poor index of contractility during pancreatitis since it decreased while myocardial contractility was increased. Cardiac depression in pancreatitis noted in other reports was likely due to decreased preload and not to intrinsic cardiac dysfunction.

Acute Disease↗
PubMed1998

Endoscope-assisted brain surgery: part 2--analysis of 380 procedures.

OBJECTIVES: Microsurgical techniques and instruments that help to reduce intraoperative retraction of normal intracranial neuronal and vascular structures contribute to improved postoperative results. To achieve sufficient control of the operating field without retraction of neurovascular components, the resection of dura and bone edges is frequently required, which, on the other hand, increases operating time and operation-related trauma. The use of endoscopes may help to reduce retraction and, at the same time, may help to avoid additional dura and bone resection. The aim of this study is to describe the principles on which the technique of endoscope-assisted brain surgery is based, to give an impression of possible indications for endoscope-assisted microsurgical procedures, and, with illustrative cases, to delineate the advantages of endoscopes used as surgical instruments during microsurgical approaches to intracranial lesions. METHODS: During a period of 4.5 years, 380 microsurgical procedures were performed as endoscope-assisted microneurosurgical operations. This surgical series was analyzed for time of surgery, usefulness of intraoperative endoscopy, and complication rates. Lens scopes with viewing angles of 0 to 110 degrees and with diameters of 2.0 to 5.0 mm as well as newly designed "viewing dissectors" (curved, rigid fiberscopes) with diameters of 1.0 to 1.5 mm connected to a video unit were used as microsurgical instruments. The positioning of the endoscopes was achieved by retractor arms fixed to the Mayfield headholder. Thus, the surgeon was able to perform customary microsurgical manipulations with both hands under simultaneous endoscopic and microscopic control. RESULTS: The lesions treated with endoscope-assisted microsurgery comprised 205 tumors, 53 aneurysms, 86 cysts, and 36 neurovascular compression syndromes. Eighty-nine of these lesions were localized in the ventricular system, 242 in the subarachnoid space or intracerebral, and 49 in the sella. Endoscope-assisted microsurgery was advantageous to reduce the size and the operation-related tissue trauma of approaches to lesions within the ventricular system, in the brain tissue as well as in the subarachnoid space at the base of the brain. Using less retraction during tumor removal, the visual control of retrosellar, endosellar, retroclival, and infratentorial structures was improved. Video-endoscope instrumentation was especially helpful during procedures in the posterior cranial fossa and at the craniocervical junction. It allowed for inspection of channels and hidden structures (e.g., the internal auditory meatus, the ventral surface of the brain stem, the ventral aspect of root entry zones of cranial nerves, the content of the foramen magnum, and the upper cervical canal), both without retraction and without resection of dura and bone edges. Endoscope instrumentation during surgery for large or giant aneurysms was useful to dissect perforators on the back side of the aneurysms and to control the completeness of clipping. CONCLUSION: Although the results reported herein cannot be compared directly with those of exclusive microsurgical procedures performed during the same period of time, videoendoscope-assisted microsurgery can be recommended as a time-saving, trauma-reducing procedure apt to improve postoperative outcomes.

Adolescent↗
PubMed1998

Review of orthopaedic manipulator arms.

Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.

Equipment Design↗
PubMed2000

Anterior cervical discectomy without fusion or instrumentation: 25 years' experience.

OBJECTIVE: To assess a minimalist approach to anterior cervical discectomy without instrumentation or bone grafting. METHOD: A total of 530 operations performed during a 25-year period were evaluated in terms of technique and patient outcome. RESULTS: Advantages included minimal blood loss, little tissue swelling, less narcotic requirement, fewer days in the hospital, and earlier return to customary activity. During the 2-year follow-up period, a repeat surgical procedure was required in only 2% of the group. CONCLUSIONS: Eliminating spinal fusion from anterior cervical discectomy shortened the operation, reduced the number of surgical instruments needed, and eliminated complications associated with obtaining a graft from the iliac crest or maintaining the bone in situ.

Adult↗
PubMed1994

[A head and transducer holding technique for TCD monitoring of the vertebrobasilar circulation].

For monitoring the Doppler spectrum of the vertebral and basilar arteries the authors have used a microball vacuum cushion for fixing the head of the patient in lateral, moderately anteflected position, and a three lockable joint type instrument holder allowing adjustment of the probe suboccipitally. This setting was used for transforaminal vertebrobasilar emboli monitoring in 5 patients having prosthetic heart valves. As an alternative technique a microball filled vacuum collar was tried out for immobilisation of the patient's head, and a snake neck type surgical instrument holder for guiding the probe.

Female↗